Provider Demographics
NPI:1851632509
Name:MINDY L GRANBERRY PLLC
Entity type:Organization
Organization Name:MINDY L GRANBERRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRANBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:512-567-2901
Mailing Address - Street 1:PO BOX 90997
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78709-0997
Mailing Address - Country:US
Mailing Address - Phone:512-261-3584
Mailing Address - Fax:512-524-3649
Practice Address - Street 1:20424 HAYSTACK CV
Practice Address - Street 2:
Practice Address - City:SPICEWOOD
Practice Address - State:TX
Practice Address - Zip Code:78669-6441
Practice Address - Country:US
Practice Address - Phone:512-261-3584
Practice Address - Fax:512-524-3649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-05
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19117235Z00000X
261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty